Provider Demographics
NPI:1194784561
Name:KIRSCH, MATTHIAS J (MD)
Entity type:Individual
Prefix:
First Name:MATTHIAS
Middle Name:J
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8218
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-6064
Practice Address - Fax:248-898-8490
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010512602085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87915Medicare UPIN
MI300F362420OtherBCBSM
MI2825497Medicaid
MI0F36242053Medicare ID - Type Unspecified